Advice on communicating with someone with mental illness is broken into four sections: Communication is a two-way process; Expressing yourself effectively; LEAP (Listen, Empathize, Agree, Partner); and Recommended Resources.
1. Created June 2014; Revised September 2020
Communicating with a Loved
One Who Has a Mental Illness
Presented by NAMI Main Line PA,
an affiliate of the National Alliance on Mental Illness
President, NAMI Main Line PA
Please view the final slide for NAMI Main Line PA contact information
and a link to the complete document this presentation summarizes.
2. Advice in Four Sections
• Communication is a two-way process.
– Why and How to Listen Well
• Expressing yourself effectively
• LEAP (Listen, Empathize, Agree, Partner)
• Recommended Resources
3. Communication is a two-way process.
– Why and How to Listen Well
Communication begins with good listening. Good
listening helps you to better understand your loved one
and helps him or her to feel heard and understood. Over
time, good listening will allow you to:
• gain valuable insight into the experiences and
motivations of your loved one
• improve your relationship with your loved one and
increase his/her willingness to hear what you have to
• break through the isolation experienced by many
people with severe mental illness.
4. Guidelines for Listening to Someone
Who Has a Mental Illness
Use reflective listening.
• Listen with the goal of understanding.
• Reflect back what you have heard and ask whether you
have understood your loved one accurately.
• Ask questions so you can understand your loved one's
experiences and point of view. Communicate your
understanding and empathy.
• Remember that if your loved one feels that you care
enough to listen and understand his/her point of view,
this will probably help to motivate him/her to be
willing to listen to you.
5. Listening Guidelines
• Even if you disagree with the person’s interpretations
of reality, try to understand his/her experiences, point
of view, hopes, fears, and beliefs about him/herself and
his/her situation. Your goal is to understand his/her
reality from his/her point of view even if he/she is
psychotic (out of touch with reality).
• Remember that a mentally ill person may have
anosognosia (the inability to perceive the mental
illness or neurological deficit) and/or delusions (fixed
beliefs that do not change in response to evidence to
the contrary), so arguing about what is real will not be
6. Listening Guidelines
Toavoid reactive listening:
• Listen to understand, rather than thinking about how
you can argue back or convince the person to change
his/her wrong beliefs.
• Avoid interrupting, criticizing or giving advice.
• Even if your loved one criticizes you, let it be.
Recognize that criticisms and blame generally come
from the illness and typically have little to do with
7. Listening Guidelines
• Tolisten well, you will want to be reasonably calm. It
may be challenging to cope with your loved one's pain,
anger, criticism and/or blame. You will be better able to
help your loved one if you can maintain some
emotional distance so you do not drown in his/her
• Tocope with this difficult challenge, you will need ways
to process any negative emotions you experience. It
will help to find support (e.g. from NAMI
programs: www.NAMIMainLinePA.org and www.nami.org).
• You may need to set limits on when, where and how
long you can listen.
8. Listening Guidelines
• These guidelines provide helpful general advice, but
individuals and situations differ, so you will need to
learn what works best in your situation and develop
modified guidelines that work well for you and your
• Additional suggestions and resources are available.
9. Expressing Yourself Effectively
• When you want to initiate a conversation on a
challenging topic, try to choose a time when
you are both calm and a time and place where
you will not be interrupted. Speak calmly.
• Use brief, concise sentences (since a person
with mental illness may have trouble
processing). Allow time for your loved one to
process what you have said and respond.
10. Expressing Yourself Effectively
Be thoughtful about how you describe a problem. Aim to
present a problem in a way that won’t trigger emotional
reactions so your loved one will be able to hear what you have
• Use "I statements".
• Describe a specific behavior that is of concern.
• Avoid attributing the behavior to character flaws or
• Avoid terms such as "always" and "never".
For example, to improve your chance of having a useful
conversation, say "I get very worried when you are gone for
several days and I don't know where you are." instead of "I'm
so upset! You are always so inconsiderate. You never think
about my feelings."
11. Expressing Yourself Effectively
• If you want to propose a change, try to focus on a
single specific proposal.
• Think about your loved one's motivations and
how you can present your proposed change in a
way that will appeal to his/her motivations (e.g.
offer some thing, activity or privilege he/she
wants or appeal to his/her self-image or concern
for other family members).
• Be flexible in considering alternative solutions
that may be a better compromise that meets the
most important needs of each person.
12. Expressing Yourself Effectively
• It is important to recognize that most problems or
issues are not resolved in a single conversation. It
usually takes a long series of conversations with
reflective listening and empathy to accumulate the
understanding and build up the trust needed to solve
• Change usually takes time and occurs gradually. Before
a person makes a significant change, there usually is a
substantial period when his/her thinking is changing as
he/she becomes more open to the possibility of
change and begins to think about how he/she might
change. Even after behavior begins to change, there
will probably be relapses (think about your own efforts
to increase exercise, eat healthier, stop smoking, etc.).
LEAP is an effective system for communicating and
collaborating to solve problems with a loved one who has a
mental illness. Briefly, LEAP includes the following sequence:
• Listen: Listen to try to understand what the person is telling
you about him/herself and his/her experiences. Reflect
back what you have heard, without your opinions and
• Empathize: Empathize with how the person feels about
his/her experiences and symptoms (without necessarily
agreeing with his/her view of reality; e.g. "That sounds
scary. Do you feel frightened?").
• Agree: Find areas of agreement, especially goals you both
want (e.g. to stay out of the hospital)
• Partner: Collaborate to work toward agreed upon goals.
LEAP is a registered trademark®. LEAP was developed by Dr. Xavier Amador. https://lfrp.org/home
During the listening step:
• Do not give your opinion unless asked; even when asked,
delay giving your opinion as long as possible, promising to
give your opinion later, after you have learned more and
understood what your loved one has to say.
• If possible, postpone responding to any requests that you
do something; say something like, "We can discuss that
later, but first I need to understand more about what you
are thinking and feeling."
• If you have listened well and built up understanding, you
are more likely to be able to provide your input in a way
that your loved one will be able to hear. If your loved one is
actively soliciting your input and has come to trust you, he
or she is much more likely to listen to your input with
• The agree step should be based on understanding what
your loved one wants and figuring out at least one goal
that you both want. This does not mean pressuring
your loved one to agree to what you want.
• In the partner step, you may want to work with your
loved one to:
– identify one or two specific goals within the overall goal(s)
you have agreed on
– identify specific steps toward achieving this goal
– agree on what each of you will do to carry out these steps
– perhaps agree on a time frame for carrying out the first
16. Recommended Resources
• We encourage you to take advantage of Family-to-
Family and other helpful programs offered by NAMI
(www.NAMIMainLinePA.org/ and www.nami.org/).
17. Recommended Resources
Resources for learning about LEAP:
• I Am Not Sick, I Don’t Need Help! by Xavier Amador
(available in paperback for $20 or Kindle edition for $10).
• Videos available here
• The LEAP Foundation for additional resources, including
information about LEAP trainings and referrals to
clinicians trained in the LEAP method
“Mental Health First Aid Guidelines” for helping
someone with depression, panic, psychosis, problem
substance use, etc.
18. Presented by NAMI Main Line PA
an affiliate of the National Alliance on Mental Illness
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